title: Bystander CPR in out-of-hospital cardiac arrest: the role of limited English proficiency.
abstract: BACKGROUND
  The proportion of non-native English speakers is increasing in the United States. We sought to determine if limited English proficiency in callers to 9-1-1 for out-of-hospital cardiac arrest is associated with provision of bystander cardiopulmonary resuscitation (CPR) and delays in telephone-assisted CPR.
  
  
  METHODS
  We completed a secondary analysis of cohort data collected as part of a randomized trial of emergency dispatcher bystander CPR instructions. Included patients suffered confirmed cardiac arrest treated by emergency medical services. Callers were identified as limited English proficient through review of the dispatcher report.
  
  
  RESULTS
  Of 971 eligible cardiac arrest cases, 5.9% (n = 57) of 9-1-1 callers were limited English proficient. Comparing arrest events of limited English proficient 9-1-1 callers with English-fluent callers, a lower proportion of limited English proficient arrest cases received bystander CPR (64.3% [36/56] vs. 77.5% [702/906]; p = 0.02) or survived to hospital discharge (8.8% [5/57] vs. 16.5% [151/914]; p = 0.12). Dispatchers took longer to recognize cardiac arrest with limited English proficient callers compared with English-fluent callers (median 84 vs. 50s; p < 0.001). Among callers attempting bystander CPR, the interval from call receipt to initiation of CPR was longer for limited English proficient compared with English-fluent callers (median 237 vs. 163s; p < 0.001).
  
  
  CONCLUSIONS
  In this observational study of dispatcher-identified cardiac arrest, limited English proficiency in 9-1-1 callers was associated with less frequent provision of bystander CPR and delays in arrest recognition and implementation of telephone CPR, underscoring the health challenges and potential disparities of pre-hospital care related to limited English proficiency.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98101, United States. smbradle@u.washington.edu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Bradley
authors.forename: Carol E
authors.initials: CE
authors.lastname: Fahrenbruch
authors.forename: Hendrika
authors.initials: H
authors.lastname: Meischke
authors.forename: Judith
authors.initials: J
authors.lastname: Allen
authors.forename: Megan
authors.initials: M
authors.lastname: Bloomingdale
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Rea
mesh_terms: D016887:Cardiopulmonary Resuscitation; D003144:Communication Barriers; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019303:Multilingualism; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies